Provider Demographics
NPI:1346066529
Name:ODERANTI, FEYIKEMI (LPN)
Entity type:Individual
Prefix:
First Name:FEYIKEMI
Middle Name:
Last Name:ODERANTI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 CARNEGIE PL
Mailing Address - Street 2:
Mailing Address - City:VAUXHALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07088-1334
Mailing Address - Country:US
Mailing Address - Phone:737-354-7949
Mailing Address - Fax:
Practice Address - Street 1:261 CARNEGIE PL
Practice Address - Street 2:
Practice Address - City:VAUXHALL
Practice Address - State:NJ
Practice Address - Zip Code:07088-1334
Practice Address - Country:US
Practice Address - Phone:973-735-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06301200164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse